Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes

Mohamed, M; Rashid, M; Farooq, S; Siddiqui, N; Parwani, P; Shiers, D; Thamman, R; Gulati, M; Shoaib, A; Chew-Graham, C; Mamas, M.A

Abstract

Background
Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness.

Purpose
To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI.

Methods
All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results
Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17).

Conclusion
Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.

Citation

Mohamed, M., Rashid, M., Farooq, S., Siddiqui, N., Parwani, P., Shiers, D., …Mamas, M. (2020). Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes. European Heart Journal, 41(Supplement_2), https://doi.org/10.1093/ehjci/ehaa946.3146

• Journal Article Type: Conference Paper
• Online Publication Date: Nov 25, 2020
• Publication Date: Nov 1, 2020
• Deposit Date: Jun 19, 2023
• Journal: European Heart Journal
• Print ISSN: 0195-668X
• Electronic ISSN: 1522-9645
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 41
• Issue: Supplement_2
• DOI: https://doi.org/10.1093/ehjci/ehaa946.3146
• Keywords: Cardiology and Cardiovascular Medicine, myocardial infarction, acute, cerebrovascular accident, ischemic stroke, bipolar disorder, hospitalization, mental disorders, psychotic disorders, schizophrenia, diagnosis, mortality, treatment outcome, major depres